two views of depression

the other day, marc challenged me with this idea: can depression, or any other challenge such as alcoholism or bipolar disorder, be an entity of its own, with its own agenda and will to survive?

i’ve been familiar with this concept for quite a while but it’s never really grabbed me. that’s why i’m grateful for marc’s challenge – i always welcome a chance to expand my mind, think differently about things.

let’s use depression as an example and compare two theories:

one: depression is an entity of its own. let’s call that the 12-step perspective. in AA, for example, alcoholism is seen as a “cunning, baffling and powerful disease”.

two: depression is a poorly executed coping mechanism. that is a systems view, advocated, among others, by psychologist virginia satir; for the sake of argument, let’s call it the “systems” view.

what would be advantage of adopting the 12-step perspective? contrary to what is the received wisdom, there is research that shows that people who attribute their misfortune to outside sources tend to be happier. viewed from a certain perspective, that makes intuitive sense, too: the opposite of attributing misfortune to an outside source is often a guilt-infused attribution (“it’s all my fault”).

in therapy, we often spend lots of time helping people dig themselves out of guilt. if i say depression is my fault because i’m too lazy, unmotivated, or passive, or because i’m not smart, attractive or all-around “good enough”, i can feel totally helpless. if, on the other hand, i believe that depression is a disease “out there”, then the enemy does not come from within. at least i’m whole at my core. personally, i remember very well the first time i realized that my depressive episodes were at least partly rooted in my body chemistry. i felt so relieved. there wasn’t something wrong with who i felt to be “me”; it was just some chemistry gone awry.

now let’s look at the advantages of taking the systems view. depression there can be taken to be a coping mechanism, an activity that one unconsciously feels driven to carry out in order to deal with frightening feelings such as fear, anger, loneliness or helplessness. it is almost a form of self medication. one “chooses” depression; of course it is not a conscious decision; it is a choice almost in the way a tortured man makes the choice to lie to his oppressors in order to save his life.

the advantage of this approach is that if the depressed person can see depression at least as partly as a choice and if she can do so without feeling guilty, then she can feel a tremendous sense of control: “i got myself into this, i can get myself out of this.” not long ago, i had a client for whom this worked very well; once he realized that depression was something he had “chosen” (the quotation marks are important!0, he decided that it was a difficult but important place of rest for him. he chose to explore depression as a space within himself that needed to be respected and integrated. when he got out of it he was much wiser and more whole.

of course, as always, these thoughts are really just thumbnail sketches; there’s much more to them. we also need to remember that there are definitely more than two ways to look at depression! having said that, here are two things that come to mind:

first, the two approaches don’t necessarily contradict each other. depression – and any other mental illness – is multifaceted. one could easily say, okay, this part seems to be an “outside force” and that part is something that on some level i’ve chosen.

secondly, the systems view can provide deep and long-lasting insight. however, not everyone is ready for that; for that matter, not everyone is interested in it.  it’s also a useful approach for someone who benefits from feeling that he or she is in full control of her or his life.

ah, control.  now there’s another topic …

32 thoughts on “two views of depression

  1. isabella mori

    @evan my heart warms to that – “taking responsibility” does have quite a victorian ring to it, doesn’t it?

    and @nancy, no, i don’t believe we are in full control, not by any degree (like, ever got hit over the head with an unexpected 404 on your own web site?).

    i think the idea that it’s good to realize agency over the things that we DO have control over often gets twisted into thinking that we have full control over our lives.

    it probably does come down to agency, no matter how you look at it. okay, so life stinks because i made it so, or life stinks because a monster made it so – what am i going to DO about it?

    of course that’s not an easy question to answer when you’re depressed, a condition that is marked by great difficulties with doing ANYTHING.

    no easy answers, ey?

  2. Wendi

    Interesting. I’ve never thought of depression as a choice I made, consciously or not. I’ve always viewed it as something that takes me over without my permission; not necessarily outside of me, but not under my control. Food for thought. Thanks.

  3. Marc Olmsted

    Thanks for addressing my question, Isabella, and rather well.
    I would quibble at depression as an “outside” force, as I think it rather an “inside” force. What I do think is that as a distinct entity {which is what I think you meant as ‘outside’) with biological origins, that it literally can reside in a part of your brain. And as a living entity, it seems to have a will to survive.
    I’m not a therapist, but I play one in real life to many a friend, and I’ve noticed how often they will come to an almost rabid defense of the rationality of the behavior that is killing them-if not physically, than spiritually. For example, an overweight friend who insists all diets are off, even somehow wrong, if there’s a festive occasion to celebrate. When I point out how his body doesn’t know the difference, he goes to battle stations at the obvious justification of his thinking. For me, this is his food addiction talking. And I have found the same with those in depression, who defend it as the only logical reaction to their circumstances. And the more likely the solution I suggest might work, the stronger they will reject it, while embracing every approach doomed to fail. What I hear is their disease only rejecting that which makes it feel threatened.

  4. Scott

    What, you mean depression isn’t caused by unhappy serotonin molecules? ;-)

    I like the systems view a lot, but I have a different spin on it. My depression resulted from being sexually assaulted when I was a child. I don’t think I “chose” to become depressed as a result of the assault, but I do recognise that my depression was a result of the PTSD that I suffered, and that the PTSD was almost certainly the result of my inability of my childhood self to cope with the trauma of being abused.

    I recovered from both conditions, but there was definitely a point in my recovery where I finally came face to face with the fact that at some point I was choosing to continue to be depressed. At that point, I no longer chose to be depressed.

    That said, I never would have reached the point where I could confront the truth about my depression if my therapist had not been able to show me how the initial cause of my depression was not my fault. I think the real danger of the “systems” approach is that it can lead sufferers to blame themselves, which just deepens the despair and hopelessness of depression.

    Scott’s last blog post..How To Start A Healing Journal

  5. Emma McCreary

    Hi,
    I’ve been enjoying your site! I just found it tonight looking for blogs about therapy.

    I want to share my experience of depression to add to the mix. I think of depression as a habit, something my body created to cope at the time. It developed into a habitual response to stress, but I wasn’t aware of that until I studied myself, my reactions, and took anti-depressants for about 4 months or so. The drugs created a little gap between the event that triggered the depression and the habitual response to get depressed – and in that gap, I could choose to not go down that mental pathway. After 4 months I had untrained myself from getting depressed and I stopped taking the medication. I have it on hand if I need it but my depression hasn’t returned in a year and 3 months. I did have a few sketchy days this winter when the days were shorter and my girlfriend broke up with me, but the habit of *not* going to depression was solid enough in me that I could consciously choose not to go there with (relative) ease. So I see myself as basically cured. (Although I am very clear that I will take the drugs again if I need to).

    Before a year ago when I went through this unlearning of depression, I suffered from depression that would recur every few months since I was a teenager, and it was awful.

    I think one of the really hard parts about depression is the way it distorts your thinking. I had to recognize that I was in a loop that went: every time I got out of a depression spell I would think it would never come back, so why investigate it? And every time it came back I was surprised. And I saw taking drugs as a weakness, that I ought to be able to solve it myself. I had to consciously look at those distortions and realize they were running me before I could make the choice to take medication and *solve* the depression instead of just suffer in it.

    Just sharing my personal experience. I also did a lot of work on emotional healing, therapy, mindfulness etc. But this was my experience around depression specifically.

    Two books that helped me: *Undoing Depression* and *Listening to Depression*.

    Also, seeing the depression as a defense mechanism that my body created to help me cope helped me accept it and heal it, rather than reject it. It was not a conscious choice, but a wise one, it helped me survive! I believe accepting the broken off parts of ourselves is the major work of healing them – it brings them back into the fold of our whole personhood. And in as much as the depression is a “separate thing”, it exists that way because we reject it. The answer is not to submit to it either. Instead I learned a process called Non-violent Communication, which is used in conflict resolution, and I used it to talk to myself, and hear with empathy the critical voices that surrounded my depression. That helped a lot too. I translated them into the feelings and needs underneath, and then I could really see that they were concerned for me. For instance the inner voice of “You’re pathetic and have no friends!” I could eventually hear as “I’m really scared that my need for belonging and acceptance will not be met!” That helped immensely and made my brain a much nicer place to inhabit. =)

    Cheers,
    Emma

    Emma McCreary’s last blog post..Aliveness vs Contrivance: Authenticity and Noise in the Rush for Blogging Popularity

  6. Evan

    Thanks for the link to the post Rudolf – I’ve bookmarked her site.

    I haven’t dealt with enough schizophrenics to know if this is a helpful approach. I certainly agree with the sentiments about the insane society with which we are expected to comply.

    My question with social explanations is always why some individuals and not others? In short it is individuals who respond to social pressure.

    I also think that it is helpful to include the rescuers role as well as aggressor and victim roles. This adds psychiatry’s role into the dynamic.

    Evan’s last blog post..Being Negative about Being Negative

  7. isabella mori

    @marc yes, the defence of the “force” – depression, addiction, whatever – is a very interesting phenomenon. “resistance”, freud called it. later on, @emma talks about “distorted thinking” (that’s what the cognitive behavioural people talk about). this resistance can fit into various theoretical models. actually, the social model that @rudolf points out – one that one of my psychology heroes, r.d. laing, promoted – easily fits in this type of resistance. if one of the major causes of depression is displaced anger at a violent family, and if at the same time one feels unable to leave the family, then one would have to “keep” the depression.

    @scott, you talk about unhappy serotonin molecules. that’s interesting because as i was thinking about writing this post, the “depression as a force” model was another model i was thinking of comparing. it seems close to the medical model.

    i like how you say that the PTSD and depression were a “result” of the trauma and that the continuation of the depression was a choice. and yes, if we talk about choice, we must talk about the involuntary or forced nature of that choice. choice and free will are most definitely not the same!

    this is one of the reasons why i like blogging. we get to have these conversations and work these things out together. what a great collaborative effort!

    @emma, thanks for taking the time to share your story. so much valuable information there!

    what you say makes total sense from the systems view. what do you guys think of saying that depression (and other forms of decreased mental wellness) can be a “coping choice”?

    as i’m thinking how helpful it would be for other people with depression to read what you have to say, of course the idea of the “distorted thinking” immediately rears its head. one of the ways one could “resist” your story would be to think, “but it’s different for >i>me!” i guess i was thinking about that when you said that initially, you resisted medication. sometimes that seems to go like this, “well, yeah, maybe it helps other people but not me.”

    what do you think?

    oh, and thanks for mentioning the two books.

    @evan – i think you’re totally right for suggesting adding psychiatry’s role into the dynamic of the “victim-aggressor” model. it’s interesting that you suggest the term “rescuer” … hmmm …

  8. Evan

    Resistance and distorted thinking. These are fun.

    It never occurs to ask about insistence.

    Distorted thinking is what other people do. My own thinking makes sense of my experience.

    I think they are both evasions of expressing disagreement. (Therapists are meant to be good boys and girls, they wouldn’t ever tell someone that they think they are wrong. To any therapists reading this try it out, try saying: I think you’re wrong, or crazy, or even, We disagree about that. Do you have resistance to doing this? Perhaps your thinking is distorted – I’m sure mine wouldn’t be, it’s in accord with CBT dogma).

    Evan’s last blog post..Being Negative about Being Negative

  9. isabella mori

    well, i personally have a problem with words like resistance or denial. but it was interesting to try these words out.

    distorted thinking is what other people do? i certainly can give you lots of examples of MY distorted thinking. give me a few hours and i’ll list it all :)

    i rarely have problems telling my clients that i disagree with them, and i’ve been known to say something like, “wow, that sounds pretty crazy to me.”

    my favourite natural model for the somewhat unnatural act of therapy is that of friendship. once in a while, when we see something that looks suspiciously like a spade, we need to help a friend out and say, “hey, come on, that square thing over there, the one you say is a duck, you ask me, i’d call it a spade!”

  10. Evan

    Thanks Isabella.

    My question is really how we arrive at the judgement of distortion. My earlier response was a bit flippant. I think our judgement of what is distorted thinking is a wholistic process, involving our rationality as well as emotionality, spirituality and physicality.

    Evan’s last blog post..Being Negative about Being Negative

  11. Emma

    @isabella
    Yes – I think the “it’s different for me” idea is one of the main “distortions” that kept me from seeking treatment. It was a thought pattern around how the depression was more “real”, and trying to be happy would make me “fake”. So therefore I knew more than everybody else because I got the delusion of it all. All those happy fake people. (Not helped by reading Nietzche LOL). Essentially, I thought the medication *would* probably help me be “happy”, but not “real”–therefore if I took it, I would be violating one of my core values of authenticity. What I eventually saw was that the depression was not my authentic self at all and that I could be authentically happy, joyful, alive, etc. When I got that, I committed to do whatever treatment would work.

    I think an essential process in there was realizing the depression was a “coping choice”, because that helped me separate it from my identity. Before that, I felt that my depressed self was an essential part of me. So I couldn’t really commit to “eradicating it”, because that would be eradicating an essential part of me.

    After realizing it was something that I took on, I could see that there was something even more authentic in me, the person I was before I went into depression. But I needed to acknowledget that the depression also served a valuable purpose for me. I learned to honor it, rather than fight it. Honor it and choose something else in present time…but still honor it.

    This is an essential part of healing to me. I did the same thing with my weight – I used to overweight and hated my body for it. Then at a certain point I decided to honor my body, deeply, for making a choice to put on weight to protect me in various ways. I think of it as another “coping choice”. Honoring that choice in me and accepting and being grateful to my body for taking care of me shifted my relationship with my weight. And after that I lost about 40 lbs without trying – no exercise or dieting. My apetite decreased on its own for about a year and the weight just came off, no struggle at all.

    As part of that, I also learned to be mindful about food and not overeat to suppress my feelings, but I did that work several years before I lost any weight. I only started losing weight after I’d done that internal shift of honoring the choices my body made to help me survive and coming to a deep acceptance and gratitude to myself for taking care of me by getting fat. LOL, it feels funny to write that but really that’s what I came to. And it’s hard because we are really taught to treat ourselves with an iron hand around weight but that never worked for me.

    Anyway, a little off-topic but I wanted to round out my experiences with healing.

    Regarding “distorted thinking” and judgment – I think there is a way to seek clarity in your thoughts without judging yourself for the delusions you still harbor. We are all ignorant until we are aware, that’s bringing in the Buddhist ideals of clarity AND compassion. I.e. discernment without judgment, i.e. wisdom.

    Isbella, I’m glad you mention that you think therapy is a somewhat unnatural act, I always have wondered about that. I find it useful, and I’m thinking of learning to be a therapist myself, but it does seem fairly contrived. It’s an open question in my mind about that, whether the contrivance is necessary because friendship is not the same as therapy – is the power imbalance necessary for a helping relationship? What did people do before therapy was invented? I guess there were always priests, and before that shamans. Hmm. More off-topic. =)

    Emma’s last blog post..Aliveness vs Contrivance: Authenticity and Noise in the Rush for Blogging Popularity

  12. JohnD

    I have found it useful to imagine depression as an independent force because that helps me, when my resilience kicks in, to get rid of it. To make it something external, separable from my real self, helps me manage the worst phases of a bad spell. That’s not the real me, I can say, that’s this alien thing that’s trying to take my place. On the other hand, every time I examine my own youth when this problem started, it seems clear that depression was indeed one of several coping mechanisms that long outlived their usefulness.

    I have to think that this particular way of coping with violence and guilt and the rest of the family scene arose from a predisposition, a genetic inheritance of some kind, because the turn to depression ran in my mother’s family.

    I find it hard to settle on an explanation for my chronic depression because most of the models have some element of truth. I think the possible pathway that Peter Kramer sketches out in his review of trends in research (Against Depression) makes the most sense to me so far. It points to a history in an individual that responds to different influences at different points in the illness’s progress. That’s a way of integrating several models in an interesting way. it doesn’t seem we’re there yet in understanding the problem fully.

    John D

    JohnD’s last blog post..Lincoln’s Adaptation to Depression

  13. Evan

    Hi Emma,

    My view (very marginal) is that the relationship is what I heals. Fake relationships don’t work. The power imbalance is largely fantasy (grandiosity from therapist, discounting from clients) except where it is in an institutional envioronment or the shrink is using their policing powers. The best therapy is a genuine friendship. But mine is a decidedly minority view.

    Evan’s last blog post..Being Negative about Being Negative

  14. Emma

    @Evan.
    Hmm. You know, thinking about it, the phrase “power imbalance” isn’t a phrase I can clearly connect to an experience I’ve had.

    What I do observe is there is an imbalance in that we spend every session talking about me. Not her. Whereas in a “genuine friendship” it would go both ways. So it’s a one-sided friendship, which means it really isn’t a friendship. So I do see a clear difference between the two. In friendship, there is mutuality. In therapy there is not, or if there is, it’s a different kind of mutuality. Each party shows up, but for different reasons.

    What I have experienced as most healing in my therapy relationship is that my therapist accepts me completely as I am. She has no agenda. Even though she is ostensibly there to help me, she is not demanding that I feel helped. This seems to be an essential component to me. Nothing is expected of me. I show up because I want to, because I choose to, but there are no demands, nothing that the therapist needs from me. She shows up entirely for me, to meet my needs, and not be about her needs. Because of that, for an hour a week, I get to experience the unconditional giving that was missing for me as a child. As far as I can tell, this is what helped me to heal an essential trust that was broken or wounded as a child.

    It was the very fact that she didn’t need me to be her friend, or be anything, and that she was there for me without expectation, that let me really trust her, and therefore be able to do the work of therapy with her. That unconditionality repaired an essential trust that was broken a long time ago. I think that unconditional presence has an alchemical property that heals over time.

    That unconditionality is not something that is present in many friendships. But perhaps a friendship based on that would indeed be healing as well.

    Emma’s last blog post..Aliveness vs Contrivance: Authenticity and Noise in the Rush for Blogging Popularity

  15. shimon

    you say: “we often spend lots of time helping people dig themselves out of guilt”
    you are right -but the idea is that the man can write the problem in paper , then he can understand better his situation.
    its very good thing to make it.

  16. merri ellen - cure depression writings

    Interesting post.

    Something definitely clicked inside me when I discovered that I couldn’t rely on my doctor to help me. I had to start doing research myself. Once I named what I had – depression – then I could search out a solution.

    Whether it was a disease for me or a coping mechanism – hmmm. I wonder if those two theories are actually stages. Meaning, stage 1 is a coping mechanism and then if left with no recovery plan, over time and perhaps at a certain point of intensity, it can become a disease (stage 2) reaching the need for shock treatment, for example.

    merri ellen – cure depression writings’s last blog post..Aug 28, Brian

  17. Emma McCreary

    @merri ellen – yup, that makes sense to me. Seems like probably a lot of mental “diseases” started as coping mechanisms. In my healing work, I’ve found many of my “problems” started that way, including overweight and sugar addiction. When I finally could find compassion for myself, forgive my body, for choosing to gain weight to protect me or to cope with the pain, then the weight was easy to shed.

    I believe it’s the welcoming back of these parts of our body/mind into our heart that creates the final healing. Of course there is behavioral stuff too, like training myself to really taste my food and not just shove it in my mouth. =) But at the end, it was compassion towards myself that helped me lose the weight. Slightly unrelated to depression, but I think the principles of healing are applicable.

  18. Pingback: The many faces of depression « Coming Out of the Trees (excerpts from my therapy journal)

  19. Pingback: 9 Ways To Deal With Job Search Depression | JobMob

  20. Madeleine, Couples Counsellor, London

    Hi Isabella and All,

    Sorry, I am somewhat of a latecomer to your post – but very much appreciate it!
    Very worthwhile to hold both concepts , including the tension between them. Your post and the comments made me think of Perls’ chairwork: let’s give each individual’s “Illness/Beast/Distorted Coping Mechanism” a voice and hear what it has to say about what if feels its role is in our life, how it may try to “help” us…
    Thanks for this.

  21. puppy potty

    Thanks, I’ve seen your blog before during my, all of the ex-pats are linked together, which is really cool. Thanks for the mention and I put your link up here too.

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